INTERNATIONAL ISSUES AND TECHNIQUES, a conference class guided by Naoli
Vinaver, Dona Irene Sotelo, Jan Tritten, and Barbara Harper, is just one
of the great classes at Midwifery Today's Eugene, Oregon conference March
22-26, 2001.

Quote of the Week:

"Joining hands and hearts around the world has a deep effect on our personal practices."

- Jan Tritten

The Art of Midwifery

When I practiced midwifery in the Houston-Galveston, Texas area, I had
the opportunity to learn this technique from the parteras in the region:
to nudge a woman into labor, have her drink comino (cumin) tea that has
a little wedge of raw potato in it. This is especially good for the woman
who is post-term and has contractions that are frequent but not quite
effective enough to get things going. Comino is gentler than castor oil
and usually did the job. I always wondered, though, why the little potato
wedge was included. The parteras didn't seem to know the rationale, either,
just that this is what you did.

News Flashes

A Spanish study of calcium consumption found that women who don't consume
enough calcium in their last trimester may have less of the mineral in their
breastmilk. Women who took in less than 900 milligrams daily during the
last part of pregnancy produced less calcium in their milk compared to those
who consumed more than 1,100 milligrams daily in the last trimesters.

Midwifery Around the World

Midwives of the Central Coast of New South Wales, Australia

Our hospital has 40 midwives trained in reflexology, a 40-hour certificate
course on reflexology and uses in midwifery practice endorsed by our midwifery
national body (ACMI). This accounts for one-quarter of the total midwifery
staff.

Our teacher was Susanne Enzer, a retired midwife and reflexologist, originally
from England and now living in Australia. Susanne facilitates seminars,
workshops and the accredited course "Maternity Reflexology."
She is also the co-author of "Maternity Reflexology: a guide for
reflexologist" (1997) and author of "Reflexology: a tool for
midwives" (2000).

Reflexology is a therapeutic system of pressure-oriented massage to feet,
hands or ears in the belief that all organs and glands have corresponding
reflex points to the body. Reflexology elicits painful or tender areas
with actual or potential disorder. It is a gentle, nonthreatening, noninvasive
effective therapy. It has the potential to balance and maintain equilibrium,
relax and increase vitality, and balance energy and move blockages.

A complementary therapies working party (3 midwives, 1 pharmacist, 1
midwifery childbirth educator) forged a policy which has been accepted
by the hospital ethics committee to practice reflexology at work.

We use reflexology in our antenatal clinics and midwife clinics for various
discomforts of pregnancy like leg and ankle odema, constipation, anxiety,
and prolonged pregnancy. In childbirth, reflexology is useful to help
enhance contractions, increase relaxation, retained placenta. Postnatally,
reflexology can assist after epidural, forcep or LSCS and urinary retention.
Difficulties relating to breastfeeding can be helped with reflexology.
Also, with exhaustion, postnatal depression. There are few contraindications-
severe PE, APH, severe PPH.

We are conducting a randomised single-blind controlled trial on the effect
of reflexology on foot and ankle oedema in late pregnancy (over 32 weeks
pregnancy). All women who met the criteria and are attending the clinics
are invited to participate in the trial. The women are randomised (after
informed consent obtained) into one of the three groups: normal pregnancy
visit (control), relaxation reflexology (placebo,) or lymphatic drainage
reflexology (treatment). The sessions are 15-20 minutes at least once
a week. The information gathered are pre- and post-treatment measurements
of ankle and instep, and blood pressure.

The women answer a questionnaire at each session about comfort, changes
in mood/feelings, and changes in relationship with midwife. The study
commenced in August 1999 and is due for completion in August 2001. Unfortunately
we will fall short of the 120 women needed as we have had only 80 women
enrolled. The difficulty of the study is the midwives do not always have
the time to give the reflexology as it is within work time and there is
no research assistant.

In a separate part of the trial, 12 women were treated with lymphatic
drainage reflexology and refused randomisation but wanted reflexology.
The characteristics of the women were mostly primigravidas (91.6%), 24-39
years old (mean of 30 years), at 33-39 weeks gestation (mean of 37.5 weeks).
The results show all measurements decreased after lymphatic drainage reflexology.
The women's blood pressure decreased (42%), increased (21%) and/or remained
unchanged (35%).

On a scale of 0 to 5, The women found a decrease in stress, tension,
anxiety, pain, tiredness, discomfort and irritability. The majority felt
"very relaxed" or "relaxed" during and after the reflexology.
Most noticed a difference in their feet after the reflexology: "more
movement," "not as tight," "less swelling." Additional
comments made by the women included "more at ease with midwives,"
"feel better about myself," and "relaxed whole body."

Although this sample is small, the many midwives have had similar comments
from women receiving reflexology. It demonstrates that reflexology has
a place in midwifery practice.

- L.M.

Papua New Guinea

Ode to Garlic

I lived and worked among the Kumboi people in the highlands of Papua New
Guinea during 1997-1998. I was the first white person they had ever seen
and was affectionately named "mbiny kuloi ai yande," the albino
daughter. I spent most of my time there alone except for a couple of visits
from my younger brother, "mba kuloi," the albino boy. I was
there to teach literacy and compile a translation of the New Testament
in their language, but healthcare inevitably took up some of my time.
I have had no official training in healthcare; however, my mother is a
midwife and herbalist and I learned much from her during my years of homeschool
on the Tennessee farm.

The main health problems in those mountains were infections of all sorts,
from skin boils and abscessed wounds to lung conditions like pneumonia--and
of course, malaria. Rather than destroy their precariously built immune
systems with antibiotics I planted a huge garlic garden and explored the
uses of that smelly herb. The village ladies were enthusiastic and we
tried everything from garlic poultices on external infections, internal
doses for parasites (we also used pumpkin seed for that), enemas (what
a job explaining the civilized reasoning behind enemas!) for pretty much
everything, a clove in the ear for ear infections, hot, garlic chest poultices
for lung infections, a few drops of diluted garlic water on an infected
umbilical cord and a warm washcloth of garlic water on the baby's belly,
garlic poultices and ingested garlic for mothers that could develop any
after-birth infections due to prolapsed uterus, etc.

I cannot give garlic all the credit for the success we had; I'm sure
God was working some miracles that we might not otherwise have had. The
most encouraging thing about the use of garlic in rural conditions is
that, when I left the village, my medical care did not go with me; it
stayed in a little patch in the middle of those thatched huts and has
continued to heal.

Kumboi Birth Traditions

Among the highland Kumboi people in Papua New Guinea, a laboring woman
must leave the village and go to a banana patch some distance from the
village. A sister will accompany her and build a crude shelter to keep
them out of the rain. The baby is born on banana leaves and kept outside
the village with the mother for about two weeks, or until the cord has
dried up and the mother's bleeding has stopped. There are many taboos
that go with this process: foods the mother may not eat, gardens she may
not enter for at least three months, people she may not talk to.

Birthing in the banana patch is mainly for the purpose of keeping the
mess outside of the village, and also serves to give the baby a better
chance to avoid infection from the chickens and pigs that run around the
village. As soon as the baby is born, the midwife/sister takes it to a
cold mountain stream and washes it in the frigid water. Along with the
high altitude and the lack of warm clothing, the baby is often cold and more susceptible to sickness. If the child lives for about two years,
it is given a name, because the chances of long-term survival are now
greater.

- Rebekah Joy Anast

====

I have a client who will be moving to Narobi, Kenya and wants to connect
with homebirth midwives there for her continued care. If anyone should
know of any, please e-mail me.

I am a new doula/aspiring direct-entry midwife in California. I am just
beginning my training here, but I am keeping an eye on the international
midwifery scene, as both my husband, who is Belgian and does quite a bit
of work in Europe, and I would like to move to Europe some day (I speak
French and Spanish).

I am passionate about midwifery and committed to getting the training
I need as a direct-entry midwife without going to nursing school, but
I worry about using that information in Europe. What is the status of
direct-entry midwives in Europe? Will I need to redo training once we
have relocated? Would getting a nursing degree help, or would I need to
get a European degree anyway?

I am a 2nd year degree student in England, UK. Our training lasts for
3 years, combined of practical and theory-based practice. We have 3-4
weeks in college and then go out onto placement for 7-8 weeks at a time
to consolidate our knowledge. It's really hard work, but so immensely
enjoyable and extremely hard to get a place in college! I really feel
that I have found my vocation in life at the ripe old age of 38!

Sadly, most British births are conducted in hospital as childbirth is
getting medicalised here. Some midwives encourage and deliver women at
home but doctors are not so keen! Only 1-2% of our births are at home.
I hope to change this when I qualify, as researching this subject has
led me to believe that it is safer, quicker and less traumatic for women
to birth at home. So why won't they?!

I am going to Spain for 3 months from Sept-Dec 2001 to appreciate how
midwifery differs there. If there are any Spanish midwives who would like
to correspond before I go there, I really would appreciate it. The place
I am going to is in the south, Murcia region.

- Debbie

====

Does anyone know of a midwife or clinic in Latin America interested in
taking apprentices? I have been apprenticing as a midwife in Colorado
for the past year and a half. A friend and I, both studying midwifery
with Ancient Art Midwifery Institute, are interested in going to Latin
America about a year from now to help deliver babies. Our preference would
be to work with a midwife doing home deliveries, but we would also like
to look into birth clinic or other options.

Editor's Note: If you enjoyed reading the above postings from
E-News readers, Midwifery Today has news for you. Read on for our latest
efforts:

International Alliance of Midwives

With the goal of birth renaissance in mind, Midwifery Today brings you
our newest baby: the International
Alliance of Midwives (IAM). All practitioners and activists interested
in birth change and international midwifery are welcome to join. As an
expression of this goal, our next international conference is titled "Birth
Renaissance." This conference will be held October 18-22, 2001 in
Paris, France.

The time has come to bring childbearing out of these most recent "dark
ages" and into the light. In some Spanish-speaking countries, the
word for light is part of the phrasing used in labor and birth terminology.
The phrase for labor is "sacar a la luz," to bring to the light.
"Dar a luz" means to give birth. Now is the time for midwives
and childbirth activists to bring the whole family-centered birth movement
"a la luz"--to the light.

IAM is a Web-based organization. We will have opportunities to meet face-to-face
at conferences. We have a directory for members on our Web site. To join
this directory, go to www.midwiferytoday.com/IAM
and follow the simple English instructions on how to enter. Spanish and
French instructions will be coming soon.

The charge for a yearly IAM membership is $20 U.S. You can pay
by Visa or MasterCard billed in U.S. dollars, or by check or money order
in U.S. dollars or British sterling. If you cannot afford to pay for a
membership, you can become a member by writing an article for the online
newsletter, by translating material into another language, or by carrying
out other volunteer tasks the alliance will need to have done.

What do you get for your membership?

- An organization that will work in sisterhood with International Confederation of Midwives (ICM) and other organizations, but will operate on a personal level, meanng the individual midwife or activist is a member
- A non-bureaucratic, grassroots, responsive organization where your voice
is important
- Access to a searchable
directory of IAM members, where you can:

* contact other members
* tell other members how to contact you
* learn what other members are doing to improve birth and what you can do to help
*describe your own birth change projects and solicit the involvement of other members
*seek quick assistance from other IAM members to apply political pressure
where needed

-An online forum for the exclusive use of IAM members, where you can:

* communicate with other members about their projects and yours
* share birth information
* establish links with the worldwide birthing community
* forge new friendships

- A subscription to the IAM newsletter, sent to you each quarter by email, with information about:

* birth and midwifery around the world
* issues, techniques and opinion pieces
* the activities of IAM
* other international news affecting birth and midwifery

- Email updates as needed but at least quarterly

Goals and Beliefs

1. Preserve, honor and learn from traditional midwives.
2. Redefine the term midwife to be inclusive of all the world's midwives.
3. Include in our membership midwives, doulas, parents, childbirth educators,
doctors and activists.
4. Value equality and diversity and strive for a communal structure.
5. Work for birth change that includes partnership with the families we serve.
6. Glean from the strengths of each country, organization and individual throughout the world to energize and fortify midwifery and further the birth renaissance.
7. Strive to de-medicalize midwifery and birth and promote evidence-based care.
8. Protect motherbaby and strive to "first, do no harm." The key is to nurture all women, including the midwife.

Let MIDIRS help you keep up to date with the latest midwifery related information with our "New Member" service.

MIDIRS collects references from 1000s of journals, Internet sites, databases and other sources of midwifery related topics and research information.

If you would like unlimited access to this information on-line, click on our link to find out more: www.midirs.org

Midwifery Today's Online Forum

I am a student midwife and I am doing an International Midwifery module. I have chosen to concentrate on midwifery education in Romania. I have one or two leads but desperately need more information. If anyone can help it would be greatly appreciated.

- Sue

Go to our forums to share your thoughts and experience.

Question of the Week

I have recently been supervising a German midwife in Manitoba who uses
Xylocaine 2% jelly to numb the perineum prior to repairing perineal tears.
Is there anything in the literature to back this practice up? I certainly
was impressed at the benefit that it provides of not distorting the tissue
as does injectable Xylocaine and the mom feels no pain. However when I
checked it out in our Pharmaceutical Reference book, it instructs us to
not apply over broken skin, etc. Do any of you use this jelly? Have there
been any negative outcomes? allergic reactions? How much should be applied
to the perineum?

Coming E-News Themes

1. BONDING: What have you observed? What do you know? What do you think?
What have you read? Read the below letter for inspiration.

A pregnant friend believes that if she cannot stay home all of the first
6 years of a child's life, she should work the first, and stay home the
next 3 because the baby won't notice that she's gone in the first years
of life. My response is
emotional and moral, not scientific at all. I hesitated to tell her my
opinion, deferring instead to what studies may have been done on the impact
of leaving a child in early years. Have you heard anything, read any books
or studies on this topic?

QUESTION OF THE QUARTER for Midwifery Today
magazine

Switchboard

Elenie asked: "I would love to know where the women are who want a non-interventive pregnancy and birth." [Issue 3:4]

I have a constant parade of them coming to my home for childbirth classes. The listserve at waterbirth@yahoogroups.com
has hundreds more. The doulas at doula@yahoogroups.com
and doula@fensende.com know hundreds
more who agonize over the lack of women/baby-centered caregivers in their
communities. In short, they are everywhere!

I was in a shanty town of Tijuana at the new year. The homes were of
cardboard. No phones, no plumbing, and often no beds. The only resource
I saw, in fact, was the women's innate concern for their babies' well
being. I accompanied a partero on his rounds and by day's end 16 of these
families were committed to a homebirth rather than contend with the indignities
of the public health hospital. Is there a true alternative in your community?

You mentioned:
" We are also working with a very low socio-economic group who are
not nurtured and are not able to do so themselves." Please don't
perpetuate the myth that poor women are any less concerned with their
babies than women who are more financially secure. I have worked for 3
years with the poorest women of the Mexican state of Jalisco, some of
whom speak indigenous languages and understand little Spanish, others
who are illiterate, and all of whom must rely on the free government-regulated
birth machine for prenatal and birth care.

Showing up at the hospital and offering to accompany these women during
their labor is the best education I could offer them. Having a stalwart
woman by her side who constantly provided a role model for position changes,
shared a cup of sweetened tea with her, and suggested alternatives to
the prevalent cookie cutter mentality was the surest way to affect change.
Why don't you consider hiring doulas to accompany your ladies?

You state: "We have women begging for induction prior to
due dates and many are skeptical that they can birth without epidurals,
or at least some narcotic. The demand for ultrasound in this population
is high and no matter how much a midwife TALKS (emphasis mine) about the
lack of medical need for one, these ladies are insistent." Sounds
to me as though your ladies aren't going to accept your *theories* without
seeing some real-life examples first! Why not keep an album that highlights
the births that have occurred in your practice without all the intervention.
Your ladies can leaf through this album and see these examples. In turn,
they can take strength from knowing that other women with little resources
from their same community have experienced the kinds of birth you are
promoting to them. Sadly, sometimes poor women think that these kinds
of births are only within reach of their financially secure sisters.

While I don't know Alto Pass, Illinois, I have participated in childbirth
education & midwifery in a southern corridor of your state. In each
of these communities there was always someone who found that the message
about non-interventive birth resonated with her inner wisdom of what would
serve her baby best. Keep offering it and you will have takers!

- Un abrazo, Joni Guadalajara, Mexico

====

On tandem nursing [Issue 3:6]:

Many children stop breasfeeding during the last trimester. That is when
colostrum is starting to replace your milk and also when your milk production
is decreasing. If you toddler is still at your breast when the baby comes,
you must give priority to the newborn, so the baby has enough to drink.
But as you continue to breastfeed both, your milk production will increase.

- Marie-Helene Lessard

====

About 5 to 6 months of pregnancy, milk will become colostrum, exactly
as if the mother was not still breastfeeding a toddler. After delivery,
the lactation will have exactly the same course as usual : colostrum,
transitional milk, and mature milk.

- Françoise Railhet Manager, LLL France Medical Associates Program

====

If your 3-year-old is nursing often, be sure your newborn gets first
priority at the breast. If you have extra help at home during your newborn's
first weeks, dad or another household helper can give your 3-year-old
extra attention so that it will be easier for you to see that your newborn's
nutritional needs are met.

Your toddler is not draining anything that will take away from your newborn.
When the baby comes you might want to try the agreement that I had with
my toddlers, that the baby had first go at the breast and then they got
to finish it off. However, since newborns usually get sleepy after one
complete feeding on one breast anyway, you can often have one on each
side. This works great for later when your milk comes in. Set up the communication
with your little one now, explaining that she/he got the breast all to
her/himself as a tiny new baby, and now it's the new baby's turn, but
how about we share.

- Amber

Midwifery Today E-News is published electronically every Wednesday. We invite your questions, comments and submissions. We'd love to hear from you!

This publication is presented by Midwifery Today, Inc., for the sole purpose of disseminating general health information for public benefit. The information contained in or provided through this publication is intended for general consumer understanding and education only and is not intended to be, and is not provided as, a substitute for professional medical advice, diagnosis or treatment.

Midwifery Today, Inc., does not assume liability for the use of this information in any jurisdiction or for the contents of any external Internet sites referenced, nor does it endorse any commercial product or service mentioned or advertised in this publication. Always seek the advice of your midwife, physician, nurse or other qualified health care provider before you undergo any treatment or for answers to any questions you may have regarding any medical condition.

Copyright Notice

The content of E-News is copyrighted by Midwifery Today, Inc., and, occasionally, other rights holders. You may forward E-News by e-mail an unlimited number of times, provided you do not alter the content in any way and that you include all applicable notices and disclaimers. You may print a single copy of each issue of E-News for your own personal, noncommercial use only, provided you include all applicable notices and disclaimers. Any other use of the content is strictly prohibited without the prior written permission of Midwifery Today, Inc., and any other applicable rights holders.